Thursday, October 15, 2009

The glint in the husband’s eyes is unmistakable as I explain the frequency with which the couple needs to have sex to increase the likelihood of getting pregnant. My patient on the other hand looks a little more skeptical. It is as though she wants to make sure this is not the result of some male conspiracy or that her spouse didn’t call me before the appointment to arrange for this advice!

For numerous patients, planning a pregnancy is a conscious decision that usually leads to behavior and lifestyle modifications. It is however unlike most other conscious decisions in our lives in that we have less control over when it may happen.

“Finish college at 21. Take a year out and travel before graduate school. Get married at 26. Get stabilized at work and married life for one to two years. Get pregnant around August so can have baby in Spring and not be pregnant when it is too hot outside!” This is how many of us try to plan our lives and for the most part we manage to stick with the agenda until it comes to the last item on the list. This lack of control can lead to anxiety and feelings that something must be wrong.

The scenario can be a familiar one. The first month is all very exciting. The couple have sex as they are advised. They both try to delay doing the home pregnancy test until at least an hour after she would have expected her period to come. Most however can’t even wait that long. They start a day or two before. Squinting their eyes as they look closer at the test strip for any faint positive signs. Then they reassure each other that they tested too early. I bet one or both of them later goes and retrieves the test strip from the garbage can just to make sure. The disappointment is clear when her period starts.

By the third month, the excitement of having sex prescribed by your doctor is all but gone. Instead, having sex is about achieving results. It is about ovulation kits, temperature spikes and the consistency of cervical mucus. All of which are, no doubt, very well known aphrodisiacs!

Anxious thoughts and insecurities begin to creep in. She feels less of a woman and him less of a man. “Maybe you need to relax. You’re too stressed.” “Maybe you need to take this more seriously". "What if something’s wrong?"

Most pregnancies happen during the first six months of trying to get pregnant. Overall, after 12 months of unprotected sex, approximately 85 percent of couples will become pregnant. Over the next 36 months, approximately 50 percent of remaining couples will go on to conceive spontaneously. This entire group is considered to have “normal fertility”. The approximately 10% that are remaining may need evaluation for decreased fertility.

Having this knowledge doesn’t necessarily make dealing with disappointments any easier. It is important for a couple to sit down before they start and discuss their approach and their goals. Having a strong foundation built on communication and mutual support will certainly help. It is important to include your healthcare provider in your discussions. He or she can make sure that you are in optimal physical and emotional health before starting on this very exciting journey.